Health Alert
SUSSEX COUNTY PAIN MANAGEMENT PHYSICIAN LICENSE SUSPENDED

The Delaware Division of Public Health (DPH) is issuing this health advisory to advise health care providers that Eva C. Dickinson’s medical license was suspended by Secretary of State Jeffrey Bullock and the Delaware Board of Medical Licensure and Discipline due to the suspension of her Maryland medical license last month in connection with alleged drug-related criminal activity. There may be former patients of Dickinson who wish to obtain opioids for pain management and individuals addicted to opiates who are at a higher risk of drug seeking, using street drugs, and overdosing.

Summary

Certain individuals with regular access to opioids — particularly if they are not well monitored by a medical practice — may be at significantly higher risk for addiction and overdose. As many as 1 in 4 people in the U.S. who receive prescription opioids long term for non-cancer pain in primary care settings struggle with addiction. Medical providers prescribing opioids should monitor patients closely, screen for addiction risk, and consider non-opioid medications for treatment of chronic pain.

Recommendations/Reporting

As the addiction epidemic continues to grow in Delaware and throughout the country, DPH is recommending that:

• Medical providers and law enforcement should be especially vigilant about potential patient overdoses or those with drug-seeking behavior, particularly in and around Harrington where Dickinson’s practice was located.
• For further information on substance abuse disorder for community members and medical providers, visit “Help is Here” at:  www.helpisherede.com. For a list of current locations that offer outpatient, inpatient, detoxification, recovery support, and recovery living, visit www.helpisherede.com/Resource-Guide/Here-for-me.
• To reduce “doctor-shopping” and to check the patient’s history for controlled substances, query the Prescription Drug Monitoring program at  http://dpr.delaware.gov/boards/controlledsubstances/pmp/default.shtml.
• Prescribers should evaluate patients for substance use disorder risk as part of any regular clinical visit but especially if they will be prescribing opioids. A sample opioid risk assessment tool can be found at the link below in the “Additional Information” section.
• If a patient appears to be at risk for substance abuse disorder, consider alternatives to opioids and/or monitor their use very closely. To the extent possible, use non-opioid therapies such as:
  • Rehabilitative services and physical therapy
  • Cognitive behavior therapy and relaxation techniques
  • Exercise and strength training
  • Non-opioid medications: acetaminophen; non-steroidal anti-inflammatory drugs (NSAIDs); serotonin and norepinephrine reuptake inhibitors (SNRIs); tricyclic antidepressants (TCAs)
• For those serving pregnant or reproductive-age women, consider also screening for alcohol abuse by using screening tools such as the T-ACE questionnaire, which can be found on www.helpisherede.com and via Google.
• Patients should be reminded to avoid taking opioids with alcohol and sedatives or tranquilizers, including benzodiazepines (i.e. Xanax and Valium); muscle relaxants (i.e. Soma or Flexeril); sleeping pills or hypnotics (i.e. Ambien or Lunesta); and other prescription opioid pain relievers unless prescribed by a health care provider.
• Patients should be reminded to lock all medications up or put them out of the way of anyone, including children or pets, who might try to consume them, whether by accident or on purpose. Patients can safely dispose of any unused medications at Delaware prescription medication drop boxes. There are 14 permanent drop boxes at this time. For a complete list of locations, visit www.delawarehealthyhomes.org.

Additional Information

• U.S. Surgeon General resources on opioids for physicians and patients:
  http://turnthetiderx.org/#
• CDC Guidelines for Prescribing Opioids:
  https://www.cdc.gov/drugoverdose/prescribing/guideline.html
• Department of State Press release on license suspension:
  http://news.delaware.gov/2017/01/19/secretary-of-state-announces-medical-license-suspension-2/
• Opioid risk assessment tool:
  https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf

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